Provider Demographics
NPI:1447214499
Name:SEGALL, NEIL C (DO)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:C
Last Name:SEGALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3814 E 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-1608
Mailing Address - Country:US
Mailing Address - Phone:303-452-2046
Mailing Address - Fax:303-280-0942
Practice Address - Street 1:3814 E 120TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-1608
Practice Address - Country:US
Practice Address - Phone:303-452-2046
Practice Address - Fax:303-280-0942
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19707207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01197078Medicaid
CO01197078Medicaid
COD28234Medicare UPIN